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AB64-ASA1,526,3
1(e) Annually, each hospital and health care system that is eligible for the
2reimbursement program under this subsection shall submit a report to the
3department containing all of the following:
AB64-ASA1,526,54 1. The number of Medical Assistance recipients served by intensive care
5coordination.
AB64-ASA1,526,106 2. For each Medical Assistance recipient who is not enrolled in coverage under
7Medicare, 42 USC 1395 et seq., the number of emergency department visits for a
8period before enrollment of that recipient in intensive care coordination and the
9number of emergency department visits for the same recipient during the same
10period after enrollment in intensive care coordination.
AB64-ASA1,526,1211 3. Any demonstrated outcomes, such as those described in par. (b) 5., for
12Medical Assistance recipients.
AB64-ASA1,526,2013 (f) For each hospital or health care system eligible for the reimbursement
14program under this subsection, the department shall calculate the costs saved to the
15Medical Assistance program by avoiding emergency department visits by
16subtracting the sum of reimbursements made under par. (d) to the hospital or health
17care system from the sum of costs of visits to the emergency department as reported
18under par. (e) 2. that were expected to occur without intensive care coordination. If
19the result of the calculation is positive, the department shall distribute half of the
20amount saved to the hospital or health care system subject to par. (h).
AB64-ASA1,526,2521 (g) No later than 24 months after the date on which the first hospital or health
22care system is able to enroll individuals in the intensive care coordination program
23under this subsection, the department shall submit a report to the joint committee
24on finance summarizing the information reported under par. (e) including the costs
25saved by avoiding emergency department visits as calculated under par. (f).
AB64-ASA1,527,6
1(h) The department shall seek any necessary approval from the federal
2department of health and human services to implement the program under this
3subsection. If the federal department of health and human services disapproves the
4request for approval, the department may implement the reimbursement under par.
5(d), the savings distribution under par. (f), or both or any part of the program under
6this subsection.
AB64-ASA1,928h 7Section 928h. 49.45 (29y) of the statutes is created to read:
AB64-ASA1,527,138 49.45 (29y) Mental health consultation reimbursement. (a) In this
9subsection, “clinical consultation" means, for a student up to age 21, communication
10from a mental health professional or a qualified treatment trainee working under the
11supervision of a mental health professional to another individual who is working
12with the client to inform, inquire, and instruct regarding all of the following and to
13direct and coordinate clinical service components:
AB64-ASA1,527,1414 1. The client's symptoms.
AB64-ASA1,527,1515 2. Strategies for effective engagement, care, and intervention for the client.
AB64-ASA1,527,1616 3. Treatment expectations for the client across service settings.
AB64-ASA1,527,1917 (b) The department shall, subject to any approval necessary from the federal
18department of health and human services, reimburse clinical consultation from the
19Medical Assistance program under this subchapter.
AB64-ASA1,527,2220 (c) By March 31, 2019, the department shall submit a report to the joint
21committee on finance on the utilization of the clinical consultation services under
22this subsection.
AB64-ASA1,527,2423 (d) The department may not provide the reimbursement for clinical
24consultation that occurs after June 30, 2019.
AB64-ASA1,928n 25Section 928n. 49.45 (39) (bm) of the statutes is repealed.
AB64-ASA1,928r
1Section 928r. 49.45 (47m) of the statutes is created to read:
AB64-ASA1,528,42 49.45 (47m) Family Care funding. (a) In this subsection, “care management
3organization” means a care management organization under contract with the
4department of health services as described under s. 46.284.
AB64-ASA1,528,85 (b) The department shall collaborate with care management organizations and
6the federal centers for Medicare and Medicaid services to develop an allowable
7payment mechanism to increase the direct care and services portion of the capitation
8rates to address the direct caregiver workforce challenges in the state.
AB64-ASA1,528,119 (c) By December 31, 2017, the department shall seek any federal approval
10necessary from the federal centers for Medicare and Medicaid services to implement
11the payment mechanism developed under par. (b).
AB64-ASA1,528,2112 (d) The department may not implement the plan developed under this
13subsection unless the department receives federal approval under par. (c). The
14department may submit one or more requests to the joint committee on finance under
15s. 13.10 to supplement the appropriation under s. 20.435 (4) (b) from the
16appropriation under s. 20.865 (4) (a) for implementation of the payment mechanism
17under par. (b). The department may only use moneys for the payment mechanism
18under par. (b) if the joint committee on finance approves the request under this
19paragraph. Notwithstanding s. 13.101, the joint committee on finance is not
20required to find that an emergency exists before making a supplementation under
21this paragraph.
AB64-ASA1,928t 22Section 928t. 49.45 (53m) of the statutes is created to read:
AB64-ASA1,529,223 49.45 (53m) Coverage program for institutions for mental disease. Subject
24to any necessary waiver approval of the federal department of health and human
25services, or as otherwise permitted under federal law, the department may, if federal

1funding participation is available, provide Medical Assistance coverage of services
2provided in an institution for mental disease to persons ages 21 to 64.
AB64-ASA1,929 3Section 929 . 49.45 (54) (b) of the statutes is repealed.
AB64-ASA1,930 4Section 930 . 49.45 (54) (c) of the statutes is created to read:
AB64-ASA1,529,125 49.45 (54) (c) Special services. From the appropriations under s. 20.435 (4) (b)
6and (o) and (7) (bt), the department may pay the costs of services provided under the
7early intervention program under s. 51.44 that are included in program participant's
8individualized family service plan and that were not authorized for payment under
9the state Medicaid plan or a department policy before July 1, 2017, including any
10services under the early intervention program under s. 51.44 that are delivered by
11a type of provider that becomes certified to provide Medical Assistance service on
12July 1, 2017, or after.
AB64-ASA1,931 13Section 931 . 49.46 (1) (em) of the statutes is created to read:
AB64-ASA1,529,2014 49.46 (1) (em) To the extent approved by the federal government, for the
15purposes of determining financial eligibility and any cost-sharing requirements of
16an individual under par. (a) 6m., 14., or 14m., (d) 2., or (e), the department or its
17designee shall exclude any assets accumulated in a person's independence account,
18as defined in s. 49.472 (1) (c), and any income or assets from retirement benefits
19earned or accumulated from income or employer contributions while employed and
20receiving state-funded benefits under s. 46.27 or medical assistance under s. 49.472.
AB64-ASA1,931n 21Section 931n. 49.46 (2) (b) 6. dm. of the statutes is created to read:
AB64-ASA1,529,2322 49.46 (2) (b) 6. dm. Durable medical equipment that is considered complex
23rehabilitation technology, subject to the requirements under s. 49.45 (9r).
AB64-ASA1,931p 24Section 931p. 49.46 (2) (b) 6. e. of the statutes is amended to read:
AB64-ASA1,530,5
149.46 (2) (b) 6. e. Subject to the limitation under s. 49.45 (30r), inpatient
2hospital, skilled nursing facility and intermediate care facility services for patients
3of any institution for mental diseases who are under 21 years of age, are under 22
4years of age and who were receiving these services immediately prior to reaching age
521, or are 65 years of age or older, or are otherwise permitted under s. 49.45 (53m).
AB64-ASA1,932 6Section 932 . 49.46 (2) (b) 17. of the statutes is amended to read:
AB64-ASA1,530,97 49.46 (2) (b) 17. Services under s. 49.45 (54) (b) (c) for children participating
8in the early intervention program under s. 51.44, that are provided by a special
9educator
.
AB64-ASA1,932n 10Section 932n. 49.46 (2) (dm) of the statutes is amended to read:
AB64-ASA1,530,1811 49.46 (2) (dm) Benefits Except as provided under s. 49.45 (53m), benefits under
12this section may not include payment for services to individuals aged 21 to 64 who
13are residents of an institution for mental diseases and who are otherwise eligible for
14medical assistance, except for individuals under 22 years of age who were receiving
15these services immediately prior to reaching age 21 and continuously thereafter and
16except for services to individuals who are on convalescent leave or are conditionally
17released from the institution for mental diseases. For purposes of this paragraph,
18the department shall define “convalescent leave" and “conditional release" by rule.
AB64-ASA1,933 19Section 933 . 49.47 (4) (c) 1. of the statutes is amended to read:
AB64-ASA1,531,620 49.47 (4) (c) 1. Except To the extent approved by the federal government and
21except
as provided in par. (am), eligibility exists if income does not exceed 133 1/3 100
22percent of the maximum aid to families with dependent children payment under s.
2349.19 (11)
poverty line for the applicant's family size or the combined benefit amount
24available under supplemental security income under 42 USC 1381 to 1383c and state
25supplemental aid under s. 49.77 whichever is lower
. In this subdivision “ income"

1includes earned or unearned income that would be included in determining
2eligibility for the individual or family under s. 49.19 or 49.77, or for the aged, blind
3or disabled under 42 USC 1381 to 1385. “Income" does not include earned or
4unearned income which would be excluded in determining eligibility for the
5individual or family under s. 49.19 or 49.77, or for the aged, blind or disabled
6individual under 42 USC 1381 to 1385.
AB64-ASA1,933n 7Section 933n. 49.47 (6) (c) 4. of the statutes is amended to read:
AB64-ASA1,531,158 49.47 (6) (c) 4. Services Except as provided under s. 49.45 (53m), services to
9individuals aged 21 to 64 who are residents of an institution for mental diseases and
10who are otherwise eligible for medical assistance, except for individuals under 22
11years of age who were receiving these services immediately prior to reaching age 21
12and continuously thereafter and except for services to individuals who are on
13convalescent leave or are conditionally released from the institution for mental
14diseases. For purposes of this subdivision, the department shall define “convalescent
15leave" and “conditional release" by rule.
AB64-ASA1,934 16Section 934 . 49.472 (3) (a) of the statutes is amended to read:
AB64-ASA1,531,2317 49.472 (3) (a) The individual's family's net income is less than 250 percent of
18the poverty line for a family the size of the individual's family. In calculating the net
19income, the department shall apply all of the exclusions specified under 42 USC
201382a
(b) and to the extent approved by the federal government shall exclude
21medical and remedial expenditures and long-term care costs in excess of $500 per
22month that would be incurred by the individual in absence of coverage under the
23medical assistance purchase plan or a Medicaid long-term care program
.
AB64-ASA1,935 24Section 935 . 49.472 (3) (b) of the statutes is amended to read:
AB64-ASA1,532,8
149.472 (3) (b) The individual's assets do not exceed $15,000. In determining
2assets, the department may not include assets that are excluded from the resource
3calculation under 42 USC 1382b (a) or, assets accumulated in an independence
4account, and, to the extent approved by the federal government, assets from
5retirement benefits accumulated from income or employer contributions while
6employed and receiving medical assistance under this section or state-funded
7benefits under s. 46.27
. The department may exclude, in whole or in part, the value
8of a vehicle used by the individual for transportation to paid employment.
AB64-ASA1,936 9Section 936 . 49.472 (3) (f) of the statutes is amended to read:
AB64-ASA1,532,1310 49.472 (3) (f) The individual maintains premium payments under sub. (4) (am)
11and, if applicable and to the extent approved by the federal government, premium
12payments
calculated by the department in accordance with sub. (4) (bm), unless the
13individual is exempted from premium payments under sub. (4) (b) (dm) or (5).
AB64-ASA1,937 14Section 937 . 49.472 (3) (g) of the statutes is amended to read:
AB64-ASA1,532,2215 49.472 (3) (g) The individual is engaged in gainful employment or is
16participating in a program that is certified by the department to provide health and
17employment services that are aimed at helping the individual achieve employment
18goals. To the extent approved by the federal government, an individual shall prove
19gainful employment and earned income to the department by providing wage income
20or prove in-kind work income by federal tax filing documentation. To qualify as
21gainful income, the amount of in-kind income shall be equal to or greater than the
22minimum amount for which federal income tax reporting is required.
AB64-ASA1,938 23Section 938 . 49.472 (4) (a) (intro.) of the statutes is renumbered 49.472 (4)
24(am) and amended to read:
AB64-ASA1,533,6
149.472 (4) (am) Except To the extent approved by the federal government and
2except
as provided in par. (b) pars. (dm) and (em) and sub. (5), an individual who is
3eligible for medical assistance under sub. (3) and
receives medical assistance under
4this section
shall pay a monthly premium of $25 to the department. The department
5shall establish the monthly premiums by rule in accordance with the following
6guidelines:
AB64-ASA1,939 7Section 939 . 49.472 (4) (a) 1. of the statutes is repealed.
AB64-ASA1,940 8Section 940 . 49.472 (4) (a) 2. of the statutes is repealed.
AB64-ASA1,941 9Section 941 . 49.472 (4) (a) 2m. of the statutes is repealed.
AB64-ASA1,942 10Section 942 . 49.472 (4) (a) 3. of the statutes is repealed.
AB64-ASA1,943 11Section 943 . 49.472 (4) (b) of the statutes is repealed.
AB64-ASA1,944 12Section 944 . 49.472 (4) (bm) of the statutes is created to read:
AB64-ASA1,533,1813 49.472 (4) (bm) To the extent approved by the federal government, in addition
14to the $25 monthly premium under par. (am), an individual who receives medical
15assistance under this section and whose individual income exceeds 100 percent of the
16poverty line for a single-person household shall pay 3 percent of his or her adjusted
17earned and unearned monthly income under par. (cm) that is in excess of 100 percent
18of the poverty line.
AB64-ASA1,945 19Section 945 . 49.472 (4) (cm) of the statutes is created to read:
AB64-ASA1,533,2320 49.472 (4) (cm) For the purposes of par. (bm), an individual's adjusted earned
21and unearned monthly income is calculated by subtracting from the individual's
22earned and unearned monthly income his or her actual out-of-pocket medical and
23remedial expenses, long-term care costs, and impairment-related work expenses.
AB64-ASA1,946 24Section 946 . 49.472 (4) (dm) of the statutes is created to read:
AB64-ASA1,534,3
149.472 (4) (dm) The department shall temporarily waive an individual's
2monthly premium under par. (am) and, if applicable, par. (bm) when the department
3determines that paying the premium would be an undue hardship on the individual.
AB64-ASA1,947 4Section 947 . 49.472 (4) (em) of the statutes is created to read:
AB64-ASA1,534,175 49.472 (4) (em) If the department determines that a state plan amendment or
6waiver of federal Medicaid law is necessary to implement the premium methodology
7under this subsection and changes to the income and asset eligibility under sub. (3)
8and s. 49.47 (4) (c) 1., the department shall submit a state plan amendment or waiver
9request to the federal department of health and human services requesting those
10changes. If a state plan amendment or waiver is not necessary or if the federal
11department of health and human services does not disapprove the state plan
12amendment or waiver request, the department may implement subs. (3) and (4) and
13s. 49.47 (4) (c) 1. with any adjustments from the federal department of health and
14human services. If the federal department of health and human services disapproves
15the state plan amendment or waiver request in whole or in part, the department may
16implement the income and asset eligibility requirements and premium methodology
17under subs. (3) and (4), 2015 stats., and s. 49.47 (4) (c) 1., 2015 stats.
AB64-ASA1,948 18Section 948 . 49.472 (5) of the statutes is amended to read:
AB64-ASA1,534,2219 49.472 (5) Community options participants. From the appropriation under s.
2020.435 (4) (bd), the department may pay all or a portion of the monthly premium
21calculated under sub. (4) (a) for an individual who is a participant in the community
22options program under s. 46.27 (11).
AB64-ASA1,949 23Section 949 . 49.472 (6) (a) of the statutes is amended to read:
AB64-ASA1,535,424 49.472 (6) (a) Notwithstanding sub. (4) (a) 3., from the appropriation accounts
25under s. 20.435 (4) (b), (gm), or (w), the department shall, on the part of an individual

1who is eligible for medical assistance under sub. (3), pay premiums for or purchase
2individual coverage offered by the individual's employer if the department
3determines that paying the premiums for or purchasing the coverage will not be more
4costly than providing medical assistance.
AB64-ASA1,950 5Section 950 . 49.497 (1m) (a) of the statutes is amended to read:
AB64-ASA1,535,216 49.497 (1m) (a) If, after notice that an incorrect payment was made, a recipient,
7or parent of a minor recipient, who is liable for repayment of an incorrect payment
8fails to repay the incorrect payment or enter into, or comply with, an agreement for
9repayment, the department may bring an action to enforce the liability or may issue
10an order to compel payment of the liability. The department shall issue the order to
11compel payment personally or by any type of mail service that requires a signature
12of acceptance from the recipient at the address of the person who is liable for
13repayment as it appears on the records of the department. The refusal or failure to
14accept or receive the order to compel payment by the person who is liable for
15repayment does not prevent the department from enforcing the order to compel
16repayment.
Any person aggrieved by an order issued by the department under this
17paragraph may appeal the order as a contested case under ch. 227 by filing with the
18department a request for a hearing within 30 days after the date of the order. The
19only issue at the hearing shall be the determination by the department that the
20person has not repaid the incorrect payment or entered into, or complied with, an
21agreement for repayment.
AB64-ASA1,951 22Section 951 . 49.497 (1m) (b) of the statutes is amended to read:
AB64-ASA1,536,923 49.497 (1m) (b) If any recipient, or parent of a minor recipient, named in an
24order to compel payment issued under par. (a) fails to pay the department any
25amount due under the terms of the order and no contested case to review the order

1is pending and the time for filing for a contested case review has expired, the
2department may present a certified true and accurate copy of the order to the circuit
3court for any county. The sworn statement of the secretary An affidavit from the
4collections unit of the department responsible for recoveries under this section
shall
5be evidence of the incorrect payment. The circuit court shall, without notice, render
6judgment in accordance with the order. A judgment rendered under this paragraph
7shall have the same effect and shall be entered in the judgment and lien docket and
8may be enforced in the same manner as if the judgment had been rendered in an
9action tried and determined by the circuit court.
AB64-ASA1,952 10Section 952 . 49.497 (1r) (a) of the statutes is amended to read:
AB64-ASA1,537,211 49.497 (1r) (a) The department may recover any penalty assessment not paid
12under s. 49.471 (9) (c) from the employer against which the penalty was assessed.
13If, after notice that payment of a penalty is overdue, the employer who is liable fails
14to pay the penalty amount, or enter into or comply with an agreement for payment,
15the department may bring an action to enforce the liability or may issue an order to
16compel payment of the liability. The department shall issue the order to compel
17payment personally or by any type of mail service that requires a signature of
18acceptance from the recipient at the address of the employer who is liable for
19repayment as it appears on the records of the department. The refusal or failure to
20accept or receive the order to compel payment by the employer who is liable for
21repayment does not prevent the department from enforcing the order to compel
22repayment.
Any person aggrieved by an order issued by the department under this
23paragraph may appeal the order as a contested case under ch. 227 by filing with the
24department a request for a hearing within 30 days after the date of the order. The
25only issue at the hearing shall be the determination by the department that the

1person has not paid the penalty or entered into, or complied with, an agreement for
2payment.
AB64-ASA1,953 3Section 953 . 49.497 (1r) (b) of the statutes is amended to read:
AB64-ASA1,537,154 49.497 (1r) (b) If any employer named in an order to compel payment issued
5under par. (a) fails to pay the department any amount due under the terms of the
6order and no contested case to review the order is pending and the time for filing for
7a contested case review has expired, the department may present a certified true and
8accurate
copy of the order to the circuit court for any county. The sworn statement
9of the secretary
An affidavit from the collections unit of the department responsible
10for recoveries under this section
shall be evidence of the failure to pay the penalty.
11The circuit court shall, without notice, render judgment in accordance with the order.
12A judgment rendered under this paragraph shall have the same effect and shall be
13entered in the judgment and lien docket and may be enforced in the same manner
14as if the judgment had been rendered in an action tried and determined by the circuit
15court.
AB64-ASA1,954 16Section 954 . 49.79 (1) (am) 4. of the statutes is renumbered 49.79 (1) (ap) 4.
AB64-ASA1,955 17Section 955 . 49.79 (1) (am) 5. of the statutes is renumbered 49.79 (1) (ap) 5.
AB64-ASA1,957 18Section 957 . 49.79 (1) (ap) (intro.) of the statutes is created to read:
AB64-ASA1,537,2019 49.79 (1) (ap) (intro.) “Able-bodied adult without dependents” means an
20able-bodied adult who is not any of the following:
AB64-ASA1,958 21Section 958 . 49.79 (1) (bg) of the statutes is created to read:
AB64-ASA1,537,2222 49.79 (1) (bg) “Custodial parent" has the meaning given in s. 49.141 (1) (b).
AB64-ASA1,959 23Section 959 . 49.79 (1) (em) of the statutes is created to read:
AB64-ASA1,537,2424 49.79 (1) (em) “Noncustodial parent" has the meaning given in s. 49.141 (1) (h).
AB64-ASA1,960 25Section 960 . 49.79 (1r) of the statutes is created to read:
AB64-ASA1,538,1
149.79 (1r) Eligibility; asset limit. (a) In this subsection:
AB64-ASA1,538,32 1. “Elderly, blind, or disabled individual” has the meaning given for “elderly or
3disabled member” in 7 USC 2012 (j).
AB64-ASA1,538,44 2. “Household” has the meaning given in 7 USC 2012 (m).
AB64-ASA1,538,95 3. “Liquid assets” means an individual's financial resources that are cash or can
6be converted to cash without incurring penalties, excluding the equity value of
7vehicles or of a home serving as the individual's primary residence. “Liquid assets”
8does not include any financial resources designated by the department by rule as
9excluded for the purposes of this subsection.
AB64-ASA1,538,1310 (b) Subject to par. (c), an individual who is not an elderly, blind, or disabled
11individual is ineligible to participate in the food stamp program in a month in which
12the household of which the individual is a member has liquid assets of more than
13$25,000.
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